A school nurse evaluates a child who is chronically soiling underwear and shows no evidence of physical illness.
What is the priority nursing action?
Refer the child to a gastrointestinal specialist.
Reprimand the child gently to encourage control.
Report suspected encopresis and begin psychosocial evaluation.
Instruct the child to eat more fiber.
The Correct Answer is C
Choice A rationale
Referring the child to a gastrointestinal specialist might be considered later, but it is not the priority action. Since the child shows no evidence of physical illness, the most likely cause of chronic soiling is functional or psychological. Addressing the potential underlying psychosocial factors takes precedence over pursuing further physical diagnostics immediately.
Choice B rationale
Reprimanding the child gently is an inappropriate and potentially harmful action. Encopresis is often involuntary and can be a source of significant shame and distress for the child. Reprimanding can exacerbate these feelings, leading to further withdrawal and potentially hindering therapeutic progress rather than encouraging control or behavioral change.
Choice C rationale
Reporting suspected encopresis and beginning a psychosocial evaluation is the priority nursing action. Encopresis, in the absence of physical illness, strongly suggests a psychological or behavioral component. A psychosocial evaluation is critical to identify underlying stressors, emotional issues, or developmental factors contributing to the soiling behavior, facilitating appropriate intervention.
Choice D rationale
Instructing the child to eat more fiber is an intervention for constipation, which can be a contributing factor to encopresis. However, it's not the priority action when there's no evidence of physical illness and chronic soiling is present. Without addressing potential psychological factors, dietary changes alone are unlikely to resolve the complex issue of non-organic encopresis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Providing a calm, structured environment with consistent routines helps children with ADHD regulate their behavior and attention. Predictable schedules and clear expectations reduce sensory overload and provide a framework for self-management, thereby promoting focus and minimizing disruptive behaviors by optimizing neurological processing.
Choice B rationale
Removing the child from the classroom as a primary intervention is counterproductive. While a brief cool-down period might sometimes be useful, consistent removal can isolate the child, disrupt their learning, and prevent them from developing coping mechanisms within the regular classroom setting, hindering social and academic integration.
Choice C rationale
Punishing a child with ADHD each time rules are broken is generally ineffective and can be detrimental. ADHD is a neurodevelopmental disorder affecting impulse control and attention; punishment alone does not address the underlying neurological differences. It can lead to increased anxiety, defiance, and a negative self-concept.
Choice D rationale
Recommending home schooling for a child with ADHD should not be the most appropriate first intervention. While home schooling can be an option for some families, it removes the child from valuable social learning experiences and peer interaction crucial for development. Classroom interventions and support should be exhausted first.
Correct Answer is B
Explanation
Step 1: May 4 is the first day of the last menstrual period.
Step 2: Add 7 days to May 4, which equals May 11.
Step 3: Count back 3 months from May, which leads to February.
Step 4: Therefore, the estimated date of delivery is February 11.
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